Premenstrual

What is Premenstrual Syndrome?

Premenstrual Syndrome (PMS) which is sometimes known as premenstrual tension (PMT) is the name given to the set of physical, psychological and emotional symptoms that appear in the time leading up to a woman’s monthly period. Symptoms commonly appear anything from two weeks to just a couple of days before your period and stop a couple of days after your period starts.

It is not uncommon for all women of child-bearing age to have some premenstrual symptoms. If often improves during pregnancy. PMS can also deteriorate (or even start for the first time) in the years leading up to the menopause. It usually disappears one or two years after the final period.

For a small number of women PMS symptoms will be severe enough to stop them living their normal lives. This is often a result of a more intense form of PMS known as premenstrual dysphoric disorder (PMDD).

The exact cause of PMS is not fully understood but it is thought to be linked to the changing levels of hormones that a woman experiences during her menstrual cycle. The variation in symptoms that women experience would suggest however, that PMS is also influenced by other factors.

There is no cure for PMS but there are treatments available that can help women to manage her symptoms.

What are the symptoms of PMS?

As many as 150 different symptoms of PMS have been reported and some
of the most common include:

Physical

Bloating/fluid retention

Headache/Migraine

Backache

tender/sore breasts

pain and discomfort in your abdomen (tummy)

generalised aches

nausea

weight gain

Psychological and behavioural

mood swings

feeling upset or emotional

feeling irritable or angry

crying

anxiety

difficulty concentrating

confusion and forgetfulness

clumsiness

restlessness

tiredness

decreased self esteem

loss of interest in sex

appetite changes or food cravings

Premenstrual dysphoric disorder (PMDD)

The symptoms of PMDD are similar to those of PMS, but are more exaggerated and women with PMDD often have more psychological symptoms rather than physical ones. Symptoms can include:

feeling of hopelessness

persistent sadness or depression

extreme anger and anxiety

decreased interest in usual activities

sleeping much less or more than usual

very low self esteem

extreme tension and irritability

PMDD can be particularly difficult to deal with and can have a negative effect on your daily life and relationships.

What are the possible causes?

As previously mentioned the exact causes are unknown but the contributing
factors are

Hormonal Changes

During your menstrual cycle, levels of hormones, such as oestrogen and
progesterone, rise and fall. Hormonal changes are thought to be the biggest
contributing factor to many of the symptoms of PMS. The fact that PMS
improves during pregnancy and after the menopause, when hormones are
stable supports this theory.

Chemical changes in the brain

Like your hormone levels, certain chemicals in your brain, such as serotonin,
fluctuate during your menstrual cycle. Serotonin is known to help regulate
your mood and make you feel happier, and so it is possible that women
with low levels of serotonin are particularly sensitive to the symptoms
of PMS. Low levels of serotonin may also contribute to symptoms such
as tiredness, food cravings and difficulty sleeping.

Stress

You may find that your symptoms of PMS become worse the more stressed
you are. Whilst not a direct cause, being stressed can aggravate the
symptoms of PMS.

Diet

Eating too much of some foods and too little of others may also affect your symptoms.
For example, too many salty foods may make you feel bloated. Caffeinated food and alcohol can disrupt your mood and energy levels. Low levels of vitamins and minerals may also make your symptoms worse so it is important to have a balanced diet.

How can a diagnosis of PMS be made?

There is no test or procedure that can diagnose PMS.

Treatment of PMS

A cure for PMS does not currently exist; the main aim is to manage the symptoms so they don’t interfere with your daily life.

If your PMS is mild or moderate, you may wish to make changes to your diet and lifestyle before resorting to medical treatment. This is because medical treatments can have side effects.

If you are finding your symptoms difficult to deal with your should see your GP or visit a sexual health clinic. You may be asked to keep a diary of your symptoms. Keeping a record of them for a couple of months before a visit to your doctor or a clinic will be really useful for them to see if any pattern is associated with how you are feeling and when you have your period.

If you live in Dumfries & Galloway you can contact the local PMS/Menopause Helpline on 01387 241121 on Thursdays between 9am and 12 noon.

Lifestyle changes

Diet

The following tips can help you maintain a healthy, balanced diet, and may also control the symptoms of PMS:

eat smaller meals more frequently to reduce bloating

avoid eating salty foods to limit bloating and fluid retention

drink plenty of water to avoid dehydration – being dehydrated can make headaches and tiredness worse

eat complex carbohydrates, which can be found in foods such as fruit, vegetables and wholegrains

eat calcium rich foods such as cheese and milk to improve the physical and psychological symptoms of PMS – if you can’t eat dairy products, try calcium fortified soya alternatives

eating plenty of fruit and vegetables, which are rich in vitamins and mineral and may ease your PMS symptoms – aim to eat at least five portions a day

avoid caffeine and alcohol, which can affect your mood and energy levels

Smoking

If you smoke, quitting may help reduce mild PMS symptoms. The Smoking Matters Service offers smokers throughout Dumfries and Galloway help in stopping smoking. You can contact Smoking Matters directly on 0845 602 6861. You can also email dgsmokingmatters@nhs.net or text on 07736 955 211 and someone will get back to you.

Exercise and relaxation

Keeping active with regular exercise may alleviate symptoms of depression and anxiety. It is one of the key steps you can take improving your overall health. Over a week activity should add up to at least 150 minutes (two and a half hours) of moderate intensity activity in bouts of ten minutes or more – one way to approach this is to do 30 minutes on at least five days a week.

Moderate intensity physical activity is anything that makes you warmer, breathe harder and your heart to beat faster but still be able to carry out a conversation for example brisk walking and cycling.

Stretching and breathing exercises such as yoga and palates can help you sleep better and reduce your stress levels.

Try and make some time each day for yourself. Doing simple things like take a warm bath or pursuing a hobby can help you relax.

Complementary treatments

There are many non-prescribed supplements and alternative treatments that claim to help treat PMS. Some women may find them helpful for easing their symptoms.

For example, supplements of calcium, vitamin D, magnesium and agnus castus (a herb known as chasteberry) may reduce some of the symptoms.
Always see your GP before taking any supplements, as taking them along side certain medicines or excessive amounts can be harmful.

Other women choose to use other alternative therapies such as aromatherapy, reflexology, homeopathy and acupuncture. These may be may be helpful in relieving some of the symptoms of PMS. It is important that women find a reputable therapist.

Many complementary therapies and supplements have either not been tested or haven’t been proven to be effective.

Psychological Therapy

It is also important that family and friends understand how you are feeling and allow you some me time.

If you have psychological symptoms, such as feeling depressed or emotional, it may help to talk to a health professional.

Cognitive behavioral therapy (CBT) is a term for a group of therapies designed to help solve problems such as anxiety and depression. A cognitive behavioral therapist can help you learn new ways of managing some of your symptoms.

Medical treatment

You may wish to try a medical treatment if your PMS is severe or you have PMDD. There is no single treatment that works for everyone. A wide range of treatments is available and it may take time to find the one that suits you. Your choice will be based on your symptoms and how severe they are, and the possible side effects of the medication.

Pain killers

Painkilling medication including paracetamol and non- steroidal anti-inflammatory drugs can relive some of the painful PMS symptoms such as muscles and joint pains, stomach cramps and headaches. Although available over the counter without a prescription please make sure you read the manufactures instructions. Children under 16 shouldn’t take aspirin and people with asthma should not take non- steroidal anti-inflammatory drugs.

Oral contraceptive pills

Combined (estrogen and progestogen) contraception either as a pill, a patch or a vaginal ring prevents the release of eggs from your ovaries. In some women this may help improve the symptoms of PMS. The progestogen only contraceptive pill called desogestrel may also prevent ovulation and can be of benefit.

Estrogen – only patches and implants

These are hormonal medications which suppress ovulation which are not contraceptives. They are usually only used to treat PMS under guidance of a gynaecologist. Unless you have had a hysterectomy they need to be combined with a hormone called progestogen to reduce the risk of thickening of the lining of the womb. For more advice see your GP.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are more commonly used to treat depression and include citalopram, fluoxetine, sertraline and paroxetine. They raise serotonin levels in the brain and promote a feeling of well being. They can help with symptoms of depression and mood swing. Like all medications they can have side effects and need to be taken for at least two cycles to see if they are of any benefit. For more advice see your GP

Gonadotrophin – releasing hormone (GnRH) analogues

Gonadotrophin – releasing hormone analogues are drugs that cause a temporary menopause.
They are used by gynaecologists in women with severe PMS when all other treatments have failed. They often have side effects. For more advice see your GP.

Support

Talking to other people can help PMS by reducing stress and sharing information.
Support, education and counselling can help improve knowledge about PMS, allowing greater understanding for both women and their families. Menopause and sexual health clinics can provide this support as well as the National Association for Premenstrual Syndrome (NAPS)